Thiazide and thiazide-like diuretics in nephrolithiasis / Diuréticos tiazídicos e tiazídicos-like na nefrolitíase

Abstract Thiazide and thiazide-like diuretics are widely used for the management of hypercalciuria among stone-forming patients. Although the effects of different thiazides should be relatively similar in terms of prevention of stone recurrence, their potency and side effects may differ. However, there is scarce data concerning the metabolic and bone effects of these agents among recurrent nephrolithiasis patients with hypercalciuria. The aim of this update article was to compare our experience in the use of thiazide and thiazide- like diuretics with that of the current literature, concerning their anticalciuric properties and consequent reduction of recurrent stone formation. Their impact on bone mass and potential side effects were also discussed.

Resumo Diuréticos tiazídicos e tiazídicos-like são amplamente usados para o tratamento da hipercalciúria em pacientes com formação de cálculos. Embora os efeitos dos diferentes tiazídicos devam ser relativamente semelhantes em termos de prevenção da recorrência do cálculo, sua potência e efeitos colaterais podem ser diferentes. No entanto, há poucos dados sobre os efeitos metabólicos e ósseos desses agentes em pacientes com nefrolitíase recorrente com hipercalciúria. O objetivo deste artigo de atualização foi comparar nossa experiência quanto ao uso de tiazídicos e tiazídicos-like com a publicada na literatura atual, no que diz respeito às suas propriedades anticalciúricas e consequente redução da formação de cálculos recorrentes. Discutimos também seu impacto na massa óssea e potenciais efeitos colaterais.

Litiasis renal en paciente pediátrico femenino tratada con litotripsia extracorpórea / Nephrolithiasis in female pediatric patient treated with extracorporeal lithotripsy

La nefrolitiasis en pacientes pediátricos es inusual. La prevalencia varía de 2 a 2.7%. Las litiasis están asociadas frecuentemente a alteraciones metabólicas y malformaciones anatomofuncionales, otras causas menos frecuentes son genéticas y nutricionales. Objetivo: identificar la nefrolitiasis como una de las causas de infección urinaria a repetición en pacientes pediátricos. Presentación del caso clínico: escolar femenina de 8 años, con peso de 22.3kg, llega a la consulta externa, de un hospital privado, del departamento de Comayagua, Honduras, por cuadros repetitivos de disuria de dos meses de evolución, con signos y síntomas de infección urinaria. Al examen físico, presentó estado general y nutricional alterado, urocultivo negativo y ecografía abdominal con presencia de litiasis. Se realizó UROTAC que confirmó la presencia de lito a nivel de la pelvis renal derecha de 17.5x8.2x13.3mm de tamaño e hidronefrosis, a nivel calicial inferior del mismo riñón se observó un conglomerado de litos de 4.5x3.5mm de diámetro. Se colocó un catéter doble J para la remisión de la hidronefrosis y la sintomatología; se realizó litotripsia extracorpórea con ondas de choque con buena fragmentación de los litos. Se recomendó a los tutores sobre la importancia de las evaluaciones periódicas, debido a la recurrencia de la enfermedad. La paciente permaneció asintomática, con buena evolución clínica y citas programadas para manejo posterior. Conclusión: Existe la posibilidad de nefrolitiasis en pacientes pediátricos, que consultan por cuadro de dolor abdominal inespecífico, historia de infección urinaria a repetición, presencia de hematuria macroscópica o microscópica, elevándose las probabilidades en aquellos que adicionalmente presenten historia de riesgo social y/o malnutrición.

Current practice of antibiotic utilization for renal colic in the emergency room

ABSTRACT Introduction Urinalysis (UA) in the emergency setting for patients with nephrolithiasis produces potentially confusing results leading to treatment of presumed urinary tract infections (UTIs). Our objective was to evaluate the use of antibiotics in patients with nephrolithiasis in a large network of emergency departments (EDs). Methods A retrospective analysis of all ED visits associated with an ICD-9 diagnosis of nephrolithiasis and a CT scan between 2010 and 2013 was performed. Urinalysis data, the use of IV and PO antibiotics during the ED visit and at discharge were assessed. The presence of fever, elevated serum WBCs, >5 WBCs per hpf, and/or dip positive nitrites were used as appropriate criteria for antibiotic use. Results Urinalysis data were available for 3,518 (70%) of 5,035 patients with an ED diagnosis of nephrolithiasis and CT imaging. Of these visits, 237 patients had positive nitrites (6.7%) and 864 had >5 WBCs per hpf (24.6%) with 158 (4.5%) having both findings for a total of 943 patients. Intravenous antibiotics were given to 244 patients (25.9%) and oral antibiotics were given to 629 patients (66.7 %) with positive UA findings. Of the 2,440 patients with a negative UA and no leukocytosis or fever, 86 patients (3.5%) received IV antibiotics and 533 patients (21.8%) received PO antibiotics upon discharge. Conclusions Proper treatment of nephrolithiasis in the ED includes the screening and diagnosis of concomitant UTIs. However, correct interpretation of UA studies is vital to the correct implementation of antibiotic therapy. This study suggests that 1/3 of patients were undertreated and 21.8% were over-treated.

Anti-inflammatory effects of royal jelly on ethylene glycol induced renal inflammation in rats

ABSTRACT Objective: In this study, anti-inflammatory effects of Royal Jelly were investigated by inducing renal inflammation in rats with the use of ethylene glycol. For this purpose, the calcium oxalate urolithiasis model was obtained by feeding rats with ethylene glycol in drinking water. Materials and Methods: The rats were divided in five study groups. The 1st group was determined as the control group. The rats in the 2nd group received ethylene glycol (1%) in drinking water. The rats in the 3rd group were daily fed with Royal Jelly by using oral gavage. The 4th group was determined as the preventive group and the rats were fed with ethylene glycol (1%) in drinking water while receiving Royal Jelly via oral gavage. The 5th group was determined as the therapeutic group and received ethylene glycol in drinking water during the first 2 weeks of the study and Royal Jelly via oral gavage during the last 2 weeks of the study. Results: At the end of the study, proinflammatory/anti-inflammatory cytokines, TNF-α, IL-1β and IL-18 levels in blood and renal tissue samples from the rats used in the application were measured. Conclusion: The results have shown that ethylene glycol does induce inflammation and renal damage. This can cause the formation of reactive oxygen species. Royal Jelly is also considered to have anti-inflammatory effects due to its possible antiradical and antioxidative effects. It can have positive effects on both the prevention of urolithiasis and possible inflammation during the existing urolithiasis and support the medical treatment.

Nefrolitíase pediátrica: uma complicação da amamentação ineficaz? / Pediatric nephrolithiasis: a complication of ineffective breastfeeding?

A nefrolitíase constitui-se na formação de conglomerados cristalinos e de matriz orgânica que podem se localizar no trato urinário, com dimensões e localização capazes de conferir significado clínico-patológico. Os fatores dietéticos têm sido mostrados como fatores de risco para a ocorrência de litíase urinária. O presente artigo teve por objetivo relatar e relacionar com a assistência de enfermagem, por meio de um plano de cuidados, um caso ocorrido entre dezembro de 2014 e fevereiro de 2015, em um hospital público do Distrito Federal, Brasil, em que a criança tinha como sintomatologia principal a eliminação de cálculos renais de diferentes tamanhos e em grande quantidade por meio do canal urinário. A associação com o aleitamento materno ineficaz é explicada no sentido em que a habilidade da criança até os seis meses de vida em manejar alguns alimentos distintos do leite materno é limitada, pois seus sistemas digestivo e renal ainda estão imaturos. Os fatos descritos neste estudo evidenciam a importância da atuação profissional no manejo do aleitamento materno exclusivo e no aconselhamento nutricional e de saúde, tendo em vista que estes são fatores modificáveis frente à prevenção de patologias e complicações.

Nephrolithiasis consists of the formation of crystalline clusters and organic matrix that can be located in the urinary tract, with dimensions and location capable of providing clinical and pathological significance. Dietary factors have been shown to be risk factors for the occurrence of urolithiasis. This article aims to describe and relate to nursing care through a care plan, a case occurred between December 2014 and February 2015 in a public hospital in the Distrito Federal, Brazil, in which the child had as main symptoms the elimination of kidney stones of different sizes and in large quantities through the urinary tract. The association with ineffective breastfeeding is explained in the sense that the child's ability to six months of life in handling some distinct breast milk foods is limited because their digestive and renal systems are still immature. The facts described in this study show the importance of professional practice in the management of exclusive breastfeeding and nutrition counseling and health, given that these factors are modifiable front of prevention of diseases and complications.

Uso a longo prazo de enalapril e hidroclorotiazida em dois pacientes com novas mutações com doença de Dent tipo 1 / The long-term use of enalapril and hydrochlorothiazide in two novel mutations patients with Dent's disease type 1

A doença de Dent é uma tubulopatia ligada ao X causada por mutações no gene que codifica o canal de cloro CLCN-5 e é caracterizada por proteinúria de baixo peso molecular, hipercalciúria, nefrocalcinose e insuficiência renal. Vários casos têm sido descritos, nos quais o único sintoma na apresentação foi proteinúria assintomática e glomerulosclerose global ou segmentar. A insuficiência renal nesses pacientes pode ser causada pela hipercalciúria e proteinúria persistente. Portanto, o inibidor da enzima de conversão da angiotensina e os tiazídicos poderiam ser úteis. O objetivo desta pesquisa é relatar os efeitos destas drogas em dois pacientes com doença de Dent tipo 1 com mutações novas. Neste relato não foram observadas correlações significativas entre dose de hidroclorotiazida e calciúria e entre enalapril e proteinúria. Este achado é importante, pois, sendo pacientes poliúricos, o uso destas drogas poderia prejudicar a função renal.

Dent's disease type 1 is an X-linked tubular disease caused by mutations in the renal chloride channel CLCN-5, and it is characterized by low molecular weight proteinuria, hypercalciuria, nephrocalcinosis, and renal failure. Several cases have been described in which the only presenting symptoms were asymptomatic proteinuria, and focal segmental or global glomerulosclerosis. The renal failure in these patients may be caused by hypercalciuria and persistent proteinuria. Therefore, angiotensin converse enzyme inhibitor and thiazides could be useful. Our aim is to report the effects of these drugs in two novel mutations patients with Dent's disease type 1. In this report, no significant correlations between dosage of hydrochlorothiazide and calciuria and no significant correlations between proteinuria and dosage of enalapril were detected. This is important since these are polyuric patients and these drugs could be dangerous to their renal function.

Phyllanthus niruri as a promising alternative treatment for nephrolithiasis

In spite of considerable efforts to identify effective treatments for urolithiasis, this is a goal yet to be achieved. This review summarizes experimental and clinical data evaluating the effect of the plant Phyllanthus niruri, a plant with worldwide distribution, as a potential agent to prevent and/or to treat urolithiasis The review is based on data from the literature and on the results obtained by our group from either in vivo/in vitro experiments or clinical studies. Phyllanthus niruri has been shown to interfere with many stages of stone formation, reducing crystals aggregation, modifying their structure and composition as well as altering the interaction of the crystals with tubular cells leading to reduced subsequent endocytosis. The clinical beneficial effects of Phyllanthus niruri may be related to ureteral relaxation, helping to eliminate calculi or to clear fragments following lithotripsy, or also to a putative reduction of the excretion of urinary crystallization promoters such as calcium. No adverse renal, cardiovascular, neurological or toxic effects have been detected in either of these studies. Altogether, these studies suggest a preventive effect of Phyllanthus niruri in stone formation or elimination, but still longer-term randomized clinical trials are necessary to confirm its therapeutic properties.

Nefrolitíase associada ao uso de indinavir: relato de caso / Nephrolithiasis triggered by indinavir use: case report

O sulfato de indinavir, em associação com inibidofores d transcripfase reversa, promove, de forma efetiva, aumento da contagem de células CD4+ e redução da carga viral (ARN-VIH) em pacientes com sindrome de imunodeficiência adquirida. Esse inibidor da protease provoca nefrolitiase em até 34,4% dos pacientes. Em decorrência do uso ainda freqüente deste antiretroviral, seus efeitos adversos devem ser prontamente reconhecidos e prevenidos, quando possível. Este trabalho descreve a associação de litíase urinária com manifestações clínicas exuberantes com o uso de indinavir.

A case of nephrolithiasis related to the use of indinavir sulfate is described. This drug, in association with reverse transcriptase inhibitors, effectively promotes a rise in the CD4+ T cell count and a decrease in the levels of HIV RNA in AIDS patients. This protease inhibitor elicits the development of nephrolithiasis in up to 34.4% of patients. Since indinavir sulfate is a frequently prescribed drug, its side effects should be well known and avoided whencver possibie.